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APA must strengthen academic psychiatry's vital role in education and research to ensure that psychiatry keeps pace with new developments in medicine and changing workforce needs.
That was the key message APA leaders heard from several psychiatrists who are deans of medical schools at a conference in late February in Rio Grande, Puerto Rico. The conference was held in conjunction with the annual meeting of the American College of Psychiatrists.
There are 14 psychiatrists who hold the position of medical school dean in the United States.
APA President Herbert S. Sacks, M.D., convened the second Deans' Advisory Conference to focus on "developing a strategy to cope with the impact of rapidly evolving workforce issues that impinge upon undergraduate medical education, the sustenance of university medical school departments, resident recruitment especially U.S. medical graduates, enhancement of our research establishments under attack by managed care, and the integration of psychiatry and psychopharmacology into the medical school curriculum."
Sacks told Psychiatric News in a later interview, "The deans have a significant investment in psychiatry and all aspects of academic medicine; therefore, we wanted them to have input into the standard-setting of psychiatry and to be aware of new initiatives in psychiatry."
The two-day conference was a continuation of the first meeting with psychiatrist deans initiated by former APA president Mary Jane England, M.D., in 1996.
The participants in the February meeting included eight deans, a university interim chancellor, and five leaders of academic psychiatry organizations. Also present were APA President-elect Rodrigo Muņoz, M.D., Vice President Daniel Borenstein, M.D., Medical Director Steven M. Mirin, M.D., and Deputy Medical Directors James Thompson, M.D. (director of the Office of Education), Harold Pincus, M.D, and Deborah Zarin, M.D. (codirectors of the Office of Research). James Scully, M.D., a former deputy medical director and director of the Office of Education, attended the meeting in his role as chair of APA's Council on Medical Education and Career Development.
To facilitate developing a workforce strategy for psychiatry, various models were presented and discussed. However, the participants concluded that questions about patient access to care and scope-of-practice issues could not be addressed adequately without first defining and agreeing on the evolving role and responsibilities of a psychiatrist.
Discussion leader Larry Faulkner, M.D., commented, "Until we clarify these practice issues and define psychiatry's role, we cannot clarify the workforce issues." Faulkner is a member of APA's Council on Medical Education and Career Development.
APA, as a leader in organized psychiatry, should collaborate with other academic psychiatry organizations on developing a vision for the role of psychiatry in the next decade, recommended the deans.
APA can also initiate a collaborative discussion on defining the core skills necessary for psychiatrists, suggested David Goldberg, M.D., executive secretary of the American Association of Directors of Psychiatric Residency Training. This will further assist psychiatry residency training directors in making appropriate assessments of their residents' readiness for practice.
Goldberg, who is also chair of APA's Committee on Graduate Education, urged APA leaders to develop research on measuring competencies for the established core skills in psychiatry.
Because the future direction of psychiatry residency education is determined by the Residency Review Committee (RRC), the deans recommended that APA, through its education components, discuss and comment on the "Special Requirements for Psychiatry" being reviewed by the RRC, according to Sheldon Miller, M.D., chair of the RRC for Psychiatry and chair of APA's Council on Addiction Psychiatry.
The declining number of U.S. medical graduates entering psychiatry also emerged as a concern of the deans. To enhance the role of psychiatry in medical school curricula, they suggested that APA promote the recent AAMC report "Medical School Objectives Project", which addresses, among other topics, medical ethics, managing psychiatric cases, and teamwork. Furthermore, APA should encourage all psychiatrist deans and chairs of departments of psychiatry to advocate that their medical schools adopt these objectives.
APA can also enhance its advocacy efforts by having credible, patient-focused data, according to Mirin. The deans recommended that APA's Practice Research Network address psychiatric scope-of-practice issues, such as the effectiveness of integrating medication and psychotherapy treatment.
Mirin also suggested that APA create a new research institute funded by external resources and operated as a separate entity to increase the credibility of APA's research efforts. Sacks commented, "I strongly support a research data institute because it would enhance the field's professionalism."
Mirin proposed the creation of a research institute to APA's Board of Trustees at its meeting last month in Washington, D.C. The Board voted to explore the proposal's feasibility and two other recommendations before making a decision in July.
The Deans' Advisory Conference was supported by unrestricted educational grants from the following pharmaceutical companies: Abbott, Eli Lilly, Forest, GlaxoWellcome, Janssen, Ortho-McNeil, Pfizer, SmithKline Beecham, Solvay, and Wyeth-Ayerst.